Author name: laura@lauracipullo.com

Feldenkrais Method & Alexander Technique By Paige Mandel, MS, RD, CDN   As previously mentioned, at Laura Cipullo Whole Nutrition, we take a holistic healing approach to address your mind, body, and spirit. To continue to nourish your connection with your mind and body, in Part Four of this series you will learn about two additional alternative treatment modalities to enhance your eating disorder treatment via awareness of the mind-body connection through movement. First, the Feldenkrais Method of somatic education: a method that uses gentle movement and directed attention to help people learn new and more effective ways of living the life they want1, by reorganizing connections between the brain and body2. Second, the Alexander Technique, defined as a system of body awareness, designed to promote well-being by ensuring minimum effort in maintaining postures and carrying out movements3.   The Feldenkrais Method of Somatic Education   The Feldenkrais Method was developed by Moshe Feldenkrais in the mid-20th century, as a “method designed to facilitate healing, self-regulation, and the emergence of self by inducing neurological change and reintegrating the central nervous system through sensory input to brain, body and the embodied mind, achieved through movement with attention”4. In short, this method is movement with attention. Feldenkrais notes that “we act according to the image that we create of ourselves”, highlighting that self-image and body image are interchangeable, as are the mind and the body4. According to Feldenkrais, his method only stimulates change and modification of the brain’s synapses with full immersion of concentration on each part of the action itself, on what was felt during the action, on the total body-image, and the effect of the action on the body image4. For individuals with eating disorders, such thorough attention and awareness of the body may feel challenging and dauting for you, as the eating disorder often causes disconnection from an accurate sense of self. Without connection to self, you are facing the challenges of recovery without access to your internal tools of self-regulation, to shift you back into your parasympathetic nervous system from persistent “fight or flight”. Yet, if you could allow yourself permission to lean in to this method, somatic educational input could help you to reconnect to your core self and even develop of new sensation of wholeness that allows you to become more aligned with your intentions and shift behaviors. A study in Germany researched the therapeutic effects of the Feldenkrais method “awareness through movement” in patients with eating disorders by providing 15 eating disordered patients a 9 hour course of the Feldenkrais Method Awareness through Movement, and compared outcomes with the patients of a control group, also consisting of 15 eating disordered patients who did not participate in a Feldenkrais course5. The results demonstrated the therapeutically effectiveness of the Feldenkrais Method with eating-disorder patients within a multimodal treatment program, as the participants of the Feldenkrais-course showed increased contentment with regard to problematic zones of their body, fostered acceptance and familiarity with their own body, more spontaneous, open and self-confident behaviors, which indicates the development of ‘felt’ sense of self, self-confidence and a general process of maturation of the whole personality5. Using this method is to knowingly reconnect with your unconscious sensorimotor patterns through sensory training. Students pay close attention to the sensation of different movement patterns, facilitating a new connection with the mind and the body in coordination. You can experience the Feldenkrais Method in two ways: Awareness Through Movement® lessonsare taught in a group setting, with students following the verbal instructions of the teacher. “Students are directed by an instructor to focus on different parts of their body, to recognize how muscles, joints, bones etc. work together to make movement happen, and then they make small adaptations to see how that changes the movement. Through these small adaptations, a deeper awareness develops and the ability to communicate more directly with the body is created”6. Functional Integration® sessions are one on one lessons where the fully clothed student is guided through touch, movement and verbal instruction1.   Go to https://feldenkrais.com/location-search/ to find a practitioner in your area!       The Alexander Technique The Alexander technique similarly focuses on body awareness, and mindfulness. The technique aims at changing the way one thinks and responds actively, rather than passively, by changing inefficient habits and patterns that interfere with our innate ability to move easily7. Food is such a large stimulus for individuals with and without diagnosed eating disorders, often triggering memories and thoughts, but also repetitive behaviors, habits. “We have a lot of habitual behaviors around food that are so ingrained and learned from such an early age that it can be very difficult even to recognize them”7. In individuals with eating disorders, if often goes beyond the accumulated tension surrounding the food, but also a disconnection with the body, an ultimate lack of trust. The Alexander technique is a reeducation of the mind and body, focusing on how does this mechanism in which I live actually work mechanically, by teaching the appropriate amount of effort for a particular activity, creating consciousness, releasing unnecessary tension7,8. Shirley Wade-Linton, an Alexander Technique teacher and Registered Dietitian explains how her ‘table work’ using the Technique can help people with eating disorders8. She highlights that the size of the body is not relevant to the Alexander teacher, and as the individual is gently taken through table work, they become fascinated by the physical change of release and openness, the transition from anxiety and fear to calm, alert, quiet and more observant8. This new connection and fascination with the body indirectly changes the relationship to their own body in a new way that is not based on size and shape.     As evidenced by the emerging interest in research on the effectiveness of alternative treatment modalities in eating disorder recovery treatment, awareness of the mind-body connection through movement is a new opportunity to help you get unstuck, from disembodied to embodied. Both the Feldenkrais Method and The Alexander Technique offer ways in which you

Reiki and Acupuncture By Rebecca Jaspan MPH, RD, CDN, CDCES Oftentimes, the practitioner specializing in eating disorders (EDO) needs to get creative to help clients diagnosed with EDO engage the parasympathetic nervous system to then create new neuropathways associated with positive sensations and healthy self-care behaviors. Learning to activate the PSN will enable the individual to feel a greater sense of calm and experience less stress at meal times. Neuroplasticity allows this individual to create a new experience of eating and even body image. As discussed in Part 2 of 4, one way to engage the parasympathetic nervous system during a meal is through breathing exercises or a body scan.  When breathing exercises aren’t working effectively or the client is unable to control their breathing, there are other avenues that can be tried in conjunction with the standard treatment for EDOs.  Two such avenues are the complementary modalities, acupuncture and reiki.   Acupuncture, a key component of traditional Chinese medicine uses very tiny needles which are inserted into the skin at strategic points your body.  Traditional Chinese medicine explains acupuncture as a technique for balancing the flow of energy, known as chi, through pathways called meridians.  By inserting needles at specific points along these meridians, acupuncture practitioners believe that your energy flow can be re-balanced.  These specific points stimulate nerves, muscles, and connective tissues that are thought to boost your body’s natural painkillers.  Acupuncture is commonly used to treat pain and is used for overall wellness and stress management.   There is also a link between acupuncture and the chakra system, which plays a key role in Ayurvedic medicine and yoga.  The chakras are the seven life-force energy centers of the body that are thought to receive, transmit, and assimilate energy.  They are aligned vertically from the base of the spine to the top of the head.  The chakras correlate with the meridians, or energy channels, that are used to balance the energy flow in acupuncture.   There is an abundance of studies with clear associations for acupuncture and depression, anxiety, insomnia, and even headaches1.  One meta-analysis showed significant evidence to support the use of acupuncture for women with major depressive disorder2.  Since about one-third of people with eating disorders are also diagnosed with depression, acupuncture may be a useful adjunct to therapy to help with negative shifts in mood and decrease anxiety often felt when individuals are stuck in a cycle of only activating their sympathetic nervous system.   In one small study, 9 women enrolled in an eating disorder treatment center consented to participate in either treatment as usual group or treatment supplemented by acupuncture.  The study showed evidence for improved Quality of Life scores measured by physical, cognitive, and psychological components of the Eating Disorder Quality of Life scale and there was also evidence that acupuncture resulted in decreased anxiety and perfectionism.  While more research is needed, there is evidence for the potential benefit of acupuncture as a complementary treatment of eating disorders1.   Additionally, reiki is a complementary modality that works with the energy fields around the body to transfer universal energy into the client.  The word “reiki” derives from Japanese meaning “mysterious atmosphere, miraculous sign”.  Reiki is shown to help treat heart disease, anxiety, depression, and chronic pain.  Also referred to as healing or therapeutic touch, reiki can help the client move toward a relationship of trust, physical, psychological, and emotional relaxation that may improve the therapeutic alliance3.  Using reiki to feel more emotionally at ease and grounded, the individual with an eating disorder may be more receptive to evidenced based eating disorder treatment.   Acupuncture and reiki help one experience their body in a new way that may contribute to forming new neuropathways and allowing meal times to feel less traumatic.  By using these modalities to decrease stress and anxiety, it can be possible to feel more relaxed and grounded, thus changing the internal experience of food and body. Be sure to find a practitioner that works with eating disorders and the Health at Every Size approach.  Your LCWNS dietitian can provide referrals to both reiki and or acupuncture providers we trust.  Being open to trying something different, may help ease the process of eating disorder recovery.   Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Acupuncture as an adjunct therapy in the treatment of eating disorders: a randomised cross-over pilot study. Complement Ther Med. 2010;18(6):233-240. doi:10.1016/j.ctim.2010.09.006 Sniezek DP, Siddiqui IJ. Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review. Med Acupunct. 2013;25(3):164-172. doi:10.1089/acu.2012.0900 Satori N. Toucher thérapeutique et anorexie mentale [Therapeutic touch and anorexia nervosa]. Soins Psychiatr. 2016;37(306):12-16. doi:10.1016/j.spsy.2016.07.002  

Engaging the PNS and the Vagus Nerve By Rebecca Jaspan MPH, RD, CDN, CDCES and Laura Cipullo, RD, CDCES, CEDRD-S, RYT   If you are going through eating disorder treatment or are in recovery, you are likely familiar with the typical treatment team.  A multidisciplinary team approach is the most common form of treatment and it is essential that a medical doctor, therapist, dietitian, and psychiatrist who specialize in eating disorders work together.  Given the complexity of eating disorders, we need to be open-minded and creative when it comes to our interventions to help when you are feeling stuck in your journey.  Alternative forms of treatment may complement your medical, nutrition and psychological care plan to help you get unstuck and then move you further along in your recovery process. This means the multidisciplinary team may include other practitioners or your current team but using new neuroplastic strategies and or modalities that help to engage the parasympathetic nervous system (PNS).   People who experience trauma can get stuck in fight, flight, or freeze and using adjunct modalities may help someone move out of this chronic state of stress, regulated by the sympathetic nervous system.  When someone is in “fight or flight,” they experience a higher heart rate and higher blood pressure, constricted blood vessels, and sweating.  When your eating disorder mind is very active, you are likely this panicked state which leads the brain to processes food and meals as “harmful”. Sitting down to a meal or snack can be experienced a mini traumatic event, which can lead to poor digestions such as bloating, gas, constipation and or diarrhea.   One idea to help change your mealtime experience is to engage the autonomic nervous system specifically known as the parasympathetic nervous system (PNS). Engaging the PNS may help you to experience food and mealtimes in a more neutral and less traumatic way.  The parasympathetic nervous system engages “rest and digest” which can help the mind, brain and body to process things more clearly by decreasing your stress hormone production and increasing your calming hormone production.  Hence, engaging the parasympathetic nervous system can be extremely advantageous, allowing your mind, brain and body to process the eating experience differently.  Eating in a state of calm versus panic feels very different and creates the opportunity for new sensations, thoughts and even neuropathways.  The key player responsible for the calming effect of the parasympathetic nervous system is known as the vagus nerve; the tenth cranial nerve that begins in the brain and influences nerves all throughout the body2.  Polyvagal theory, developed by Stephen Porges, gives us more insight into how the vagus nerve works and why it is such an important player in our eating experiences.   Polyvagal theory explains that the vagus nerve is thought to have two branches that play different roles in the nervous system.  The front side of the vagus nerve supports feelings of physical safety and promotes emotional connection to others.  The back side of the vagus nerve responds to cues of danger, pulling us out of connection, awareness, and into a state of self-protection3.  When the back of the vagus nerve is activated, you may experience yourself in the “hyper or hypoarousal zone”.  “Hyperarousal zone” may look like defensiveness, racing thoughts, and emotional overwhelm.  “Hypoarousal zone” may feel numbing, disconnected, and ashamed.  You may be activating the back of your vagus nerve when you sit down to a meal with feelings of fear and anxiety. You can engage the parasympathetic nervous system by activating the front side of the vagus nerve through deep breathing, meditation, and other techniques to access what is called the “optimal zone of arousal”.  You will know you are in the “optimal zone” when you feel grounded in your body, are aware in the present moment, and can tolerate your feelings.  When you sit down to a meal, and activate the PNS through breathwork, you will now have the opportunity to process the food and meal in a more neutral and curious way.  Additionally, your body will likely digest your meal more effectively so you will likely experience less gas, constipation and/or bloating. A few breathing exercise you can try to help create this new eating experience and activate new neuropathways around meal behaviors include: ujjayi breathing, four square breathing, and alternative nostril breathing.   If you feel you stuck in your recovery process, know there are many options to create new neuropathways and engage your PNS. Your dietitian at LCWNS will be more than happy to teach you the above breathing exercises or a body scan.  At Laura Cipullo Whole Nutrition, we take a holistic approach to address your mind, body, and spirit.  “Leaning in” a little more may just make recovery a tad bit easier. Keep reading learn about ways to get unstuck in Part 3 Reiki and Acupuncture of this blog series Neuroplasticity, The Parasympathetic Nervous System and Eating Disorder Recovery.   References: Tindle J, Tadi P. Neuroanatomy, Parasympathetic Nervous System. [Updated 2020 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553141/ Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018;9:44. Published 2018 Mar 13. doi:10.3389/fpsyt.2018.00044 Porges SW. The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleve Clin J Med. 2009;76 Suppl 2(Suppl 2):S86-S90. doi:10.3949/ccjm.76.s2.17 Fogarty S, Smith CA, Hay P. The role of complementary and alternative medicine in the treatment of eating disorders: A systematic review. Eat Behav. 2016;21:179-188. doi:https://doi.org/10.1016/j.eatbeh.2016.03.002

Getting Unstuck Using Neuroplasticity When Recovering From An Eating Disorder By Laura Cipullo RD, CEDRD-S, RYT   Many individuals who have been diagnosed with an eating disorder are considered to have experienced trauma and or have been diagnosed with PTSD, similar to a veteran of war or survivor of abuse. “Trauma is stored in somatic memory and expressed as changes in the biological stress response, creating undischarged energy in the nervous system (specifically in the amygdala, thalamus, hippocampus, hypothalamus, and brain stem) not accessible” to the understanding, thinking, reasoning part of your brain known as the frontal cortex. Individuals may have been traumatized and possibly not even recognize or recall the experience. On the other hand, Post- Traumatic Stress Disorder is characterized by a persistent re-experiencing of the traumatic event (intrusions), regular avoidance of anything associated with the trauma, an effort to numb oneself to all feelings and thoughts, and finally, a constant state of arousal known as fight, flight or freeze by way of being “stuck” in the autonomic nervous system’s sympathetic response.(1). Keep in mind, many individuals can be traumatized by more than one event or experience. Meal times and body image can both be experienced as traumatic for clients with eating disorders, especially those who have already experienced trauma earlier in their life.   Eating disorders are considered disorders of the brain involving neurological, physical, emotional, cognitive and social processes. Therefore, when creating a care plan and team for someone with an eating disorder, one must consider a holistic treatment plan to address all of these systems. Through Functional MRIs and PET Scans, it is apparent that individuals with eating disorders are wired differently than individuals without eating disorders. This means there are greater and or lesser levels of activity in parts of the brain. As healthcare practitioners, parents or individuals with eating disorders, it is wise to consider neuroplasticity to help the individual with an eating disorder stuck in the sympathetic response of flight fight or freeze.  Neuroplasticity is defined as the brain’s ability to reorganize itself by forming new neural connections throughout life, especially in response to learning or experience. This means individuals can use their brain to unwire old patterns associated with traumatic experiences, and then reconnect the mind, brain and body when in a state of calm, to stimulate new, healthy neuropathways. Studies have demonstrated the benefits of neuroplastic changes (rewiring the brain) in the ED brain through exposure to specific movement interventions such as the Feldenkrais Method (see Part 4 for more information) and or trauma-informed yoga. (2,3)   Dr. Moshe Feldenkrais observed that in order for there to be real long-term behavior change, one must change the way they sense and move in their body. (2)     Dr. Norman Doidge, author of The Brain That Changes Itself, explains that neuroplasticity allows for the development of resourcefulness and flexibility, yet is also capable of producing rigid habits and behaviors. He says “Just as there is a path into an eating disorder, there is a path to recovery, with both pathways stemming from the brain’s ability to be altered by thoughts and behavior.” (3) As eating disorder specialists, parents and or individuals suffering with an eating disorder, we need to explore using both the top-down approach of talk therapy and cognitive therapies with and the bottom up approach through movement and sensory motor modalities. In other words, “a healthy self is an embodied experience, learned through body sensations and proprioception which create new neuropathways.” This means we need to help clients identify their body sensations in a new way to create a healing and or positive experience of themselves, their meals and their body (body image). (2) The common saying is “Where attention goes, neural firing occurs, and where neurons fire, new connections can be made.” This means when one is internally aware, present and without judgement, they can connect previously isolated segments of their brain. This will help to release the fight, flight or freeze response and engage the parasympathetic nervous system to access a state of calm to wire new healthy neuropathways associated with positive feelings and thoughts around food and body. (2,3)   Whether post COVID, or just a normal day, most clients with eating disorders operate in the PTSD state of fight, flight or freeze and or experience meal time as traumatic. This makes treatment feel uncomfortable and sometimes seemingly counterproductive for both the provider and the client. Neuroplasticity offers a new perspective and a more holistic treatment model. As RD’s and eating disorder specialists, we can help our clients by using other adjunct modalities to create new neuropathways and or refer to other practitioners employing a “bottom up” approach.  To create these new pathways and remove the stuck quality resulting from trauma, we need to first or simultaneously help clients engage their parasympathetic nervous system. Self Exercises to engage the PNS include breathing, mindfulness meditation and yoga and mindful meals. Include specialists in Feldenkrais, Rolfing, Cranial Sacral Therapy, Reiki, Somatic Experiencing, EMDR, Acupuncture and Trauma Informed Yoga to create brain-changing electrical pathways. Research shares “by increasing brain circuitry through bodily movement with attention and self-awareness, somatosensory education…in connecting body with mind, and brain with body… fosters the neurophysiological reintegration of the core self that is embodied,” (2) which can provide the opportunity to move forward on the journey of recovery from an eating disorder.   Ramirez, M.A., RYT-200, G. M. (2019).Single Yoga Session Effect on Anxiety and Body Image in Eating Disorders [Doctoral dissertation, Xavier University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1566813967139149 Natenshon, Abigail. “Clinical Application of Neuroplastic Brain Research in Eating Disorder Treatment.”The Open Access Journal of Science and Technology, vol. 4, 2016, https://doi.org/10.11131/2016/101219. The National Institute for the Clinical Application of Behavioral Medicine, Ruth Buczynski, PhD How to work with clients who are stuck (Educational video modules) including but not limited to…How to Engage the Parts of the Brain that Get Stuck After Trauma, Part 1: Bessel van der Kolk, MD How the Unconscious

Neurobiology’s Role in Eating Disorders: Understanding and Treatment By Reva Schlanger MS, RD, CDN   I was fortunate enough to attend IAEDP’s most recent webinar: “A Neurobiology Understanding of Eating Disorders: Applying Concepts to Treatment”, by Dr. Jeffrey DeSarbo (a psychotherapist dedicated to helping those struggling with eating disorders). This webinar helped explain the neurobiological underpinnings and an eating disorder and how the brain is affected. One of the major points Dr. De Sarbo conveyed is eating disorders are a serious medical/biological condition, and NOT a choice.   Dr. De Sarbo discussed how the brain functions with the body; there is always an ebb and flow to maintain homeostasis. There is a constant interaction between our brain/central nervous system and thus, how the rest of the body functions, until something drastic happens (like restriction). When am individual restricts their intake for greater than 24 to 8 hours, their body’s whole system suffers, especially the brain. There can be a loss of brain mass, change in the brain anatomy, and brain chemistry, a change in brain blood flow, and in neuro-hormone, as well. This affects thoughts, cognitive processing, feelings and behaviors.   This helps one to understand why an individual with an eating disorder such as anorexia nervosa person cannot just “start eating” or someone with binge eating disorder cannot just have “self-control”. It is not an act of stubbornness, rather a function of neurobiology in how they process information. Basically, a starved brain is a slow brain causing communication between different systems in the body to become delayed. Hence, we may observe a person with an eating disorder lose focus in class or start to struggle with getting good grades or have difficulty socializing with friends. The body is in a traumatic state.   All eating disorders, regardless of the type of EDO, are received by the brain as trauma. Keep in mind while all eating disorders present differently, they all are a serious mental health and biological medical condition and not an individual’s choice. Someone’s thoughts, feeling and behaviors are a result of their neurobiology, which can change pending trauma in the form of restriction, overeating, purging, overexercise…   Here at Laura Cipullo Whole Nutrition Services, we aim to take note of the individual’s familial and personal history, age of menstrual cycle (if female), vitals, weights, and labs to start. We also pay close attention to the fact that some individuals are or have experienced more trauma than others. It has been helpful to teach our clients patience, mindfulness, and compassion when working on recovery from an eating disorder. Not only does this help both the client and Rd, but is also helps to change the neurological processing in the brain. Our blogs in January 2022 will cover a 4 part series on neuroplasticity, the parasympathetic nervous system and eating disorder recovery.  

Exercise Variety: Essential for Eating Disorder Recovery By Rebecca Jaspan MPH, RD, CDN, CDCES What is your relationship with exercise?  Throughout your recovery journey, healing your relationship with movement goes hand in hand with healing your relationship with food and body.  For many with a history of overexercising, you may have gotten stuck in the same exercise routines: possibly long runs outside, hours on the elliptical machine, or daily bootcamp classes a week. A healthier relationship with movement means varying your workout routines and resting, too.  There are so many ways to move your body and several important benefits to changing it up on a regular basis.  Research shows that it is important to get four types of exercise: endurance, strength, balance, and flexibility1. Endurance activities such as walking, biking, dancing, or playing a sport increase your breathing and heart rate.  They promote heart health and can help to prevent conditions like diabetes and cancer. Endurance exercise has positive effects on skeletal muscle in regulating protein synthesis.  There is evidence that despite the many additive benefits of endurance exercise for disease prevention and athletic performance, combining both endurance exercise with strength training promotes more muscle gain, strength, and power than doing either type of exercise alone2. Strength exercises build muscle and help make every day activities easier.  These types of exercises can include using weights or resistance bands and can be very effective with using just your own body weight.  You want to vary the types of muscle groups you work as well, rather than focus on the same muscles throughout the week. Balance is also important for overall health. You may not even realize how much good balance plays a role in almost every you do, from walking, getting up from a chair, to getting dressed each morning.  Balance training involves exercises that strengthen your balancing muscles, including your legs and core.  These exercises promote stability and prevent falls.  You can practice your balance by standing on one foot, doing a heel to toe walk, and doing certain yoga poses. And finally stretching can improve your flexibility, which is important for overall health.  Flexibility is crucial to help you perform every day activities with more ease and it is also helpful for mobility and injury prevention.  When you stretch on a regular basis, you can improve your range of motion, which gives you more freedom of movement. One study found both static stretching , holding a stretch for 30 seconds or longer, and dynamic stretching, doing several repetitions of stretching movements, are beneficial for increasing range of motion3.  Additionally, dynamic stretching improves your performance in physical activity my preparing your body for subsequent motion, power, and strength4. Here are three reasons why it is important to switch up your exercise routine to incorporate all four types of exercise. Prevent overuse injuries Tiny tears and damages occur in our muscles, tendons, and ligaments when we exercise and resting those body parts while using others allows them to recover and prevent overuse injuries.  Different exercises compound on themselves, so getting better and stronger at one workout will help you improve at other workouts.  If you are focusing on the same workouts over and over again and not noticing improvements, it could be because you aren’t getting enough variation in the types of workouts you are doing. Prevent fatigue and muscle soreness We need a combination of both easy and hard workouts.  If you’re working out really hard all of the time, you may notice more fatigue and muscle soreness.  Easier workouts and taking full days off completely allow the body to rest, repair, and prevent burnout. Keep exercise fun Changing up your workouts keeps exercise interesting, challenging, and less boring!  Try a dance class once a week, replace a cardio day with yoga, or alternate between jogging and walking.  Notice how your body feels with more variety in your exercise routine and by doing this, you are changing your relationship with exercise to one of self-care and honoring your body.   https://www.nia.nih.gov/health/four-types-exercise-can-improve-your-health-and-physical-ability Fyfe JJ, Bishop DJ, Stepto NK. Interference between concurrent resistance and endurance exercise: molecular bases and the role of individual training variables. Sports Med. 2014;44(6):743-762. doi:10.1007/s40279-014-0162-1 Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012;7(1):109-119. Opplert J, Babault N. Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature. Sports Med. 2018;48(2):299-325. doi:10.1007/s40279-017-0797-9

Finding the Ideal Step Count for Health and Longevity By Paige Mandel, MS RD CDN     A common knee-jerk response to the arbitrary question of “how many steps should I take in a day?” is most often 10,000 steps. But where did this magic number come from? I tried to ask myself this question as well, which led me to thinking… I don’t really know where that number in my head came from. While duration and intensity of exercise is an individualized recommendation, in almost all of my graduate nutrition courses and trainings we learned at least 150 minutes of moderate intensity exercise per week is optimal for the health of the general adult population. This actually comes from the Physical Activity Guidelines for Americans1, published by the U.S. Department of Health and Human Services. But, there was no evidence-based step count we were taught to recommend for such benefits.   The 10,000-steps target became popular in Japan in the 1960s, according to Dr. I-Min Lee, a professor of epidemiology at the Harvard T.H. Chan School of Public Health and an expert on step counts and health.2 This “magic step count” made way with the production of a pedometer, created to capitalize on consumer interest in fitness after the 1964 Tokyo Olympic Games. The pedometer’s name was written in Japanese characters which translated in English to “10,000 steps meter” and resembled the image of a walking man2. With this, came the popularity of the 10,000 step goal, which infiltrated the globe and fitness tracking industry. A target based on market capitalization, not necessarily science.   So now that we’ve surmised where the magic number came from we have to ask ourselves, is this legitimate? Will taking 10,000+ steps per day really have significant impact on my health and longevity? Until recent studies, the research highlighted the benefits of increased activity for increased longevity, with no marked point of reverse effect.   We know from previous research that people who are active are more likely to outlive those who are sedentary, as the risk of premature death decreases with increased movement. In 2018, the CDC concluded ~10% of all deaths among Americans 40-70 years of age are result of too little exercise3. In 2019, Dr. Lee and her colleagues found that the risk of early death for women in their 70’s was reduced by 40% for those women who completed 4,400 steps a day in comparison to those who completed 2,700 or less, with risks continuing to drop among women walking more than 5,000 steps2. This study saw a plateau of benefits around a step count of 7,500 daily steps2. In this study, there were only slight statistical benefits of additional steps up to and beyond the 10,000-step mark, demonstrating the gap in the research: is there an upper limit to the benefits of exercise for a longer, healthier life?  At this point, it was not completely clear whether we could overdo exercise, potentially contributing to a shorter life.   Two emerging studies were published this year, focusing on closing this gap and finding the exercise “sweet spot”, where the cost doesn’t outweigh the benefits.   One study published in August 2021 aimed to investigate the association between the duration of weekly leisure-time sports activity and all-cause mortality4(p). The results were observed as a U-shaped association, with lowest risk (highest benefit) for those participating in 2.6 to 4.5 weekly hours of activity. If you think about the shape of a U, the benefits lie at the bottom of the curve, a decrease in risk of mortality, where with both less AND more activity, benefits declined. Among the relatively few people who worked out for 10 hours or more per week, or about 90 minutes or so most days in this study, the results demonstrated a decline in benefit, increased risk of mortality by one third, comparative to people exercising for 2.6 to 4.5 hours a week3,4(p). This study concluded that the potential risks of very high activity levels should also be considered for inclusion in guidelines and recommendations4(p).   The second study published in September 2021, actually focused on the step count itself, further validating these results. The results demonstrated that participants accumulating at least 7,000 steps/day were 50% less like to have died since, than those who took fewer, with mortality risk decreasing up to 70% comparatively in those taking more than 9,000 steps/day3,5. Similarly to previous research, the benefits plateaued at 10,000 steps/day, with participants reaching this goal or more rarely outliving those who accumulated at least 7,0003,5.   With this new research, we can estimate the exercise “sweet spot” to be ~7,000-8,000 steps/day or 30-45 minutes of exercise most days. Not too little, not too much. It is most important to listen to your body to reap the meaningful benefits of exercise.   In summary, the most recent research tells us, yes, there is an association between increased activity and longevity/health benefits. The risk of premature death can be reduced by as much as 70% by incorporating the “right” amount of physical activity3. It also tells us no, being more active does not directly cause increased lifespan – we do not need to hit the “magic” 10,000 step count to reap the benefits of daily exercise for optimal health, sometimes less can be more.   References: Physical Activity Guidelines for Americans, 2nd edition. :118. Reynolds G. Do We Really Need to Take 10,000 Steps a Day for Our Health? The New York Times. https://www.nytimes.com/2021/07/06/well/move/10000-steps-health.html. Published July 6, 2021. Accessed October 27, 2021. Reynolds G. How Much Exercise Do We Need to Live Longer? The New York Times. https://www.nytimes.com/2021/09/15/well/move/exercise-daily-steps-recommended.html. Published September 15, 2021. Accessed November 15, 2021. Schnohr P, O’Keefe JH, Lavie CJ, et al. U-Shaped Association Between Duration of Sports Activities and Mortality: Copenhagen City Heart Study. Mayo Clin Proc. 2021;0(0). doi:10.1016/j.mayocp.2021.05.028 Paluch AE, Gabriel KP, Fulton JE, et al. Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in

Insights and Press: Featuring Laura and Rebecca CLICK TO READ Rebecca’s Article Featured In VeryWell Fit: The Turkey Trot Deserves Your Thanksgiving Attention CLICK TO WATCH Laura on CBSN: How to have… A Healthy Thanksgiving Meal Tips to A Moderate and Mindful Thanksgiving Meal by Laura Cipullo, RD Focus on what you can have: It’s not about what you can’t have. Instead focus on what you can have. Identify what you really want to eat and then eat it. It’s not cheating, it’s just a choice. Make leftovers first. The secret is to pacing your meal is to make a leftovers plate, first. Come to the table, create a plate or Tupperware before you sit down the dinner meal. Wrap this plate to enjoy the day after. Now you have no reason to overeat;  all your favorite foods are to be eaten on day 2.  Sit down to dinner and pace yourself on you favorite fixings, stopping when you are full. Food does not have the same taste when we are full, so its best to wait and enjoy your leftover plate the day after.  Sit, savor and hydrate: One meal with more sugar and or saturated fat will not affect your overall long-term health, however it may give you a food hangover. To prevent the food hangover, eat slowly, savor and drink plenty of water. Mix and match the fats:Save the saturated fats for the gravy, stuffing and desserts. Choose the anti-inflammatory fats like olive oil and nuts for dressing your veggies and building flavor. Season plants with plants:Thanksgiving is best holiday to focus on eating earth’s rainbow. Think fresh carrots roasted with thyme and parsley. Brussel Sprouts simmered in miso paste and a tiny bit of honey. Toast almonds to cover green beans. Serve salad with crunchy pomegranate seeds and pumpkin seeds. Think about adding turmeric or cumin to cauliflower. Basically, season with plants with plants. 🙂 Set yourself up with structure: Follow your normal schedule, eating breakfast and lunch. Enjoy your appetizers around snack time and Thanksgiving meal as your dinner. Make the choice to eat moderately so you feel good when you wake up Friday ready for the holiday season. Don’t worry about what you are eating instead focus on how much and be sure to taste your food.